Provider Demographics
NPI:1295420073
Name:OWEN, DEBRA LYNN (CNA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:OWEN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-5409
Mailing Address - Country:US
Mailing Address - Phone:510-499-4031
Mailing Address - Fax:
Practice Address - Street 1:1031 WHALEN RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9524
Practice Address - Country:US
Practice Address - Phone:360-488-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61369888376K00000X
WANC61369888376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide